Bowel Ischaemia

Question 1

What is it?

Answer 1

Compromised arterial blood supply to bowel normally due to thromboembolism
Risk factors: Af, Smoking, Vasculopathy

Question 2

What are clinical features?

Answer 2

Severe abdo pain out of proportion to clinical fidnings
N&V
Rectal bleeding
Non specific tenderness
May have AF

Question 3

What are the investigations?

Answer 3

ABG- high lactate, metabolic acidosis
Triple phase CT with IV contrast to confirm

Question 4

What is the management?

Answer 4

Emergency surgery
IV abx and resus

Question 5

What is chronic bowel ischaemia?

Answer 5

Atherosclerosis of coeliac trunk, SMA or IMA cuasing gradual arterial narrowing
Ischaemic pain post food

Question 6

What are symptoms of chornic bowel ischaemia?

Answer 6

Abdo pain 15-30 mins after eating lasting up to 1 hour
Anorexia
Significant weight loss

Question 7

What are the investigations and management of chronic bowel ischaemia?

Answer 7

CT angio= gold standard

Risk factor modification
Angiograpgy with stenting or bypass surgery

Question 8

What is ischaemic colitis?

Answer 8

Acute compromise of blood flow to colon causing mucosal injury
Can be caused by septic shock, heart failure, VTE

Question 9

What are clinical features of ischaemic colitis?

Answer 9

Acute onset crampy abdo pain
Haematochezia
Diarrhoea
Systemic upset
Abdo distension and tenderness over affected area
Generalised peritonism if perforation

Question 10

What is the investigations and management of ischaemic colitis?

Answer 10

CT abdo- 1st line
AXR may show thumbprinting and mural thickening

Initial resus and supportive management
Surgery ifperforation or peritonitis